By Daniel Corliss
When most health plan brokers and advisors look at how to trim the most fat off medical costs in a self-funded plan, they look at the high dollar claims, specialty facilities, inpatient and elective surgeries. These usually achieve the bulk of the savings opportunities along with Rx formulary and drug switch potential. Saving money for a health plan is very important and obviously the biggest benchmark of our success and performance as brokers and plan advisors. But, what about some of the smaller things that can bring savings to health plans, and offer value and convenience to the end user, the plan member?
Enter, Direct Primary Care (DPC) and a new era of delivering low-cost and unlimited access to primary care that focuses on the patient and not insurance carrier pre-authorizations, unnecessary diagnostic and lab testing, or treating illness with a prescription pad at every opportunity. This is healthcare delivered by a physician that cares about your health and well-being rather than carrier reimbursements and pharmaceutical kickbacks. DPC practices and physicians are only paid by their patient membership, and they have a passion for making a difference in healthcare today.
It’s a feasible solution for employers who have employees and families that live near DPC clinic locations and could replace the need for a traditional PPO network. It can provide fast, convenient patient-centered care with little to no wait times. A DPC could be a great alternative for a small business that can’t afford a traditional group health plan but wants to offer a healthcare solution to their employees or patrons at very low cost. I also know of people with chronic illness such as diabetes, high blood pressure, and heart disease that ditched their regular PPO plan for DPC due to their need for 3-4 primary care visits per month. Meeting their deductible, paying their co-pay, and sitting in a miserable waiting room 30 to 40 minutes every time they needed to see their physician proved less affordable and…upsetting.
There’s no better example of a passionate DPC physician than Aimee Ostick, M.D. of Health & Healing Direct Primary Care in Woodland Hills, CA. It was a circuitous route that led her to start her own DPC clinic. She did her undergraduate degree at Santa Monica College and UC Berkeley. She then attended Sidney Kimmel Medical College at Thomas Jefferson University for medical school and residency. She then trained in family medicine. After her residency, Dr. Ostick worked for Kaiser Permanente for 5 years and served a fellowship in community medicine where she practiced in free clinics and Federally Qualified Health Centers (FQHC) around the San Fernando Valley. After her time at Kaiser, Dr. Ostick joined HealthCare Partners and practiced at a high-risk clinic that focused on patients that were “frequent flyers” of the acute care system and needed critical and compassionate attention. Dr. Ostick later joined the UCLA medical system for twp years before finally coming to a head with some very real problems in healthcare and care delivery today: affordability and accessibility.
She became frustrated with the bureaucracy and red tape that prevented her from practicing medicine the way she was trained, and for the Hippocratic Oath she swore to practice under – focusing on the patient’s health and best interests. So, she decided to leave her job at UCLA and start her own Direct Primary Care practice in Woodland Hills, in September of 2019. She embraced juggling the ongoing duties of being a primary care physician (PCP) while parenting three children with husband Brian Ostick, M.D., director of ER services at Valley Presbyterian Hospital in Van Nuys.
“I am passionate about family medicine because it treats the whole person and in the best-case scenario, the whole family,” says Dr. Aimee Ostick. “We have a broad scope of knowledge which makes us a great partner in our patient’s healthcare. We guide patients through complex medical conditions in a convoluted medical system. I decided to start a DPC practice because primary care in the current insurance-based system is not tenable or sustainable,” she explained. “I cannot be the PCP I was trained to be in that system. Patients deserve time and access to their primary doctor, not rushed visits and blockades. We get so much training on the psychosocial determinants of health, and then can’t put any of that into practice in the current system.”
I remember meeting Aimee and her husband Brian at the Los Angeles Association of Health Underwriters (LAAHU) holiday party. It was clear they go above and beyond for their patients when they shared great moments they’d had along their healthcare journey. They described a night when a DPC member called after hours because their child had somehow managed to get a piece of an apple lodged into a nasal cavity. The parents were not able to get it out. The Ostick’s told the family to bring the child to their home. The doctors were able to use special extraction equipment to successfully remove the piece of fruit without harming the child. And without a costly, time consuming and traumatic visit to an ER.
Direct Primary Care is intrinsically compassionate and accessible in its design. It allows physicians like Dr. Ostick to practice unlimited patient-centered care in any appropriate setting imaginable – and all for a monthly fee that is less than the cost of most single PPO primary care visits. DPC memberships range in cost based on geography, demographic, specialty, scope and whether the member is single, single with children, or married with children. Due to the elimination of billing and collection staff overhead, the cost is very affordable.
I’ve listed Health & Healing’s prices below to give reference for what you may typically see out in the marketplace:
- Pediatric
o with at least one adult membership $39/month
o without adult membership $89/month
- Adult $89/month
- Senior $99/month
- Family $199/month – includes 2 adults, 2 children ($20/additional child)
- There is a one-time non-refundable $99 registration fee per household.
- After hours and home visits available within a 10-mile radius for a $99 per visit fee
While DPC can be more affordable and convenient, it might not be for everyone. If you travel a lot or are an employer with employees spread across multiple regions with little or no access to DPC clinics, it may not be for you.
Where it is effective, DPC provides significant savings for health plans and individuals. As important is the added value in focused care and improved convenience that you cannot hang a price tag on. Expect to see this trend and physicians like Dr. Ostick be much more present in 2020 and for years to come in emerging markets like Los Angeles and all of Southern California.
Daniel Corliss is large group health and benefit plan advisor at DC Advisory, LLC in Los Angeles. Reach him at: daniel@dcadvisoryllc.com.